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Accepted for/Published in: JMIR Formative Research

Date Submitted: Feb 8, 2021
Date Accepted: Sep 18, 2021

The final, peer-reviewed published version of this preprint can be found here:

A Web-Based, Population-Based Cirrhosis Identification and Management System for Improving Cirrhosis Care: Qualitative Formative Evaluation

Javier S, Wu J, Smith DL, Kanwal F, Martin LA, Clark J, Midboe AM

A Web-Based, Population-Based Cirrhosis Identification and Management System for Improving Cirrhosis Care: Qualitative Formative Evaluation

JMIR Form Res 2021;5(11):e27748

DOI: 10.2196/27748

PMID: 34751653

PMCID: 8663449

Population-Based Cirrhosis Identification and Management System (P-CIMS) for Improving Cirrhosis Care: A Qualitative Formative Evaluation of a Web-Based Tool

  • Sarah Javier; 
  • Justina Wu; 
  • Donna L. Smith; 
  • Fahisa Kanwal; 
  • Lindsey A. Martin; 
  • Jack Clark; 
  • Amanda M. Midboe

ABSTRACT

Background:

Cirrhosis, or scarring of the liver, is a debilitating condition affecting millions of U.S. adults. Early identification, linkage to care, and retention in care are critical to preventing severe complications from cirrhosis and death.

Objective:

The purpose of this study was to conduct a pre-implementation formative evaluation to identify factors that could impact implementation of the Population-Based Cirrhosis Identification and Management System (P-CIMS) in clinics serving patients with cirrhosis. P-CIMS is a web-based informatics tool designed to facilitate patient outreach and cirrhosis care management.

Methods:

Semi-structured interviews were conducted with frontline providers in liver disease and primary care clinics at three Veterans Health Administration medical centers. The Consolidated Framework for Implementation Research guided the development of interview guides. Inductive consensus coding was used to analyze transcribed interviews and abstracted coded passages elucidated themes and insights.

Results:

Ten providers were interviewed, including eight physicians and mid-level providers from liver-related specialty clinics and two primary care providers who managed patients with cirrhosis. Overall, P-CIMS was viewed as a powerful tool for improving linkage and retention but its integration in the clinical workflow required leadership support, time, and staffing. Providers also cited the need for more intuitive interface elements to enhance usability.

Conclusions:

P-CIMS shows promise as a powerful tool for identifying, linking, and retaining in care patients living with cirrhosis. The current evaluation identified several improvements and advantages of P-CIMS over current care processes and provides lessons for others implementing similar population-based identification and management tools in chronic disease populations.


 Citation

Please cite as:

Javier S, Wu J, Smith DL, Kanwal F, Martin LA, Clark J, Midboe AM

A Web-Based, Population-Based Cirrhosis Identification and Management System for Improving Cirrhosis Care: Qualitative Formative Evaluation

JMIR Form Res 2021;5(11):e27748

DOI: 10.2196/27748

PMID: 34751653

PMCID: 8663449

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